WHAT IS BIPOLAR DISORDER?

Bipolar disorder (commonly referred to as manic-depression) is a major affective disorder in which an individual alternates between states of deep depression and extreme euphoria (mania).

WHAT ARE THE SIGNS AND SYMPTOMS OF BIPOLAR DISORDERS?

The essential feature of bipolar disorder is recurrent, remitting, cyclical episodes of both mania and depression throughout the course of the illness with one or more manic episodes usually accompanied by one or more major depressive episodes. Most frequently the initial episode that leads to hospitalization is manic.

It is essential to understand that this disorder is characterized by different degrees of intensity of the symptoms in either the manic or the depressive stage. In the manic episode mood is elevated, expansive or irritable. Other manifest features are hyperactivity, pressure of speech, flight of ideas, and diminished need for sleep, increase self esteem to the point of grandiosity, distractibility, poor judgment and short attention span.

In the depressive phase there is a manifest disturbance of mood. Clinical depression manifests these features with greater severity and duration than those that may appear as transient episodes of sadness in association with one's usual life experiences. In this phase of the disorder the patient may manifest depressed mood, loss of interest or pleasure, loss of weight, insomnia, retardation of both speech and motor function, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to think or concentrate and indecisiveness. There may also be possible recurrent thoughts of death or suicidal ideation. In this phase of the disorder there is a significant high and serious risk of patient death by suicide.

WHAT IS THE AVERAGE AGE OF ONSET OF BIPOLAR DISORDER?

In adults most typically onset occurs between 25-35 years of age. Of course there are incidences of occurrences both earlier and later than this. Recently much work has taken place trying to identify symptoms that could denote the onset of this condition in children and adolescents. Diagnosis in this population requires the opinion of a specialist in this area.

WHAT TYPE OF TREATMENTS ARE AVAILABLE?

The first and best-established treatment is Lithium, which was introduced in 1949. Lithium is still the only treatment approved for mania and the prevention of recurrences. Other treatments have been introduced for the manic phase such as several antipsychotics. Also, a number of anticonvulsants have been proposed as well. CBZ, (carbamazapine), VAL(valproate), Lamictal, Neurontin, etc. (See: Strakowski SM, DelBello MP, Adler CM. Comparative Efficacy and Tolerability of Drug Treatments for Bipolar Disorder. CNS Drugs. 2001. 15(9):701-718)

WHAT KIND OF SUPPORT PROGRAMS ARE AVAILABLE FOR BIPOLAR PATIENTS AND THEIR FAMILIES?

There are many support groups throughout the United States and worldwide. Here are just a few:

Child & Adolescent Bipolar FoundationThe Child and Adolescent Bipolar Foundation (CABF) is a national, not-for-profit organization of parents raising children diagnosed with (or at risk for) bipolar disorder, and people who care about them.
http:www.bpkids.org

Dutch Association for Manic Depressives - NetherlandsSponsors psycho-educational courses to provide information and teach coping skills to bipolar patients, their families and friends.
http://www.nsmd.nl

The Josselyn Center for Mental HealthA not-for-profit corporation dedicated to providing high quality interdisciplinary mental health and related services to families and individuals of all socioeconomic backgrounds. It has served Chicago's north shore communities since 1951.
http://www.josselyn.org

The Winnipeg Mood Disorder Association of CanadaFounded in 1983 as a self-help organization to provide support, information and education to those affected by mood disorders. fosters public awareness of the social, biochemical and psychological factors in mania and depression through education in the media. Assists those with mania and depression to obtain professional help.
http://www.depression.mb.ca

National Alliance for the Mentally Ill (NAMI)NAMI is a nonprofit, grassroots, self-help, support, and advocacy organization of consumers, families and friends of people with severe mental illnesses, such as schizophrenia, major depression, bipolar disorders, obsessive-compulsive disorder and anxiety disorders.
http://www.nami.org

National Depressive and Manic Depressive Association (NDMDA)The mission of the NDMDA is to educate patients, families, professionals and the public concerning the nature of depressive and manic-depressive illness as treatable medical diseases; to foster self-help for patients and families; to eliminate discrimination and stigma; to improve access to care and to advocate for research toward the elimination of these illnesses.
http://www.ndmda.org

IF TREATED, CAN THE BIPOLAR PATIENT FUNCTION IN SOCIETY?

Many patients can have a return to effective functioning. A positive outcome is related to early diagnosis and institution of effective treatment.

WHAT IS THE AVERAGE LENGTH OF TREATMENT?

Initially acute treatment is employed - this treatment is given during the period from the beginning of a manic or depressive episode to remission. In the case of successful antidepressant drug treatment, acute treatment usually lasts from 6-12 weeks.

Continuation treatment is the ongoing treatment of a depressive or manic episode from the point of clinical remission to the point at which spontaneous remission would be expected to occur in untreated patients. Although overt clinical symptoms of illness may remit rapidly, an underlying tail of vulnerability can remain for some time. The duration of continuation treatment is determined by the natural course of illness.

Long-term maintenance (prophylactic) treatment is intended to prevent or attenuate future episodes of bipolar disorder, and it is used somewhat more selectively than are acute and continuation treatments.

Duration of treatment depends on the number and frequency of episodes.

IS BIPOLAR DISORDER HEREDITARY?